Virtual Reality Therapy Versus Cognitive Behavior Therapy for Social Phobia: A Preliminary Controlled Study

Abstract

Social phobia is one of the most frequent mental disorders and is accessible to two forms of scientifically validated treatments: anti-depressant drugs and cognitive behavior therapies (CBT). In this last case, graded exposure to feared social situations is one of the fundamental therapeutic ingredients. Virtual reality technologies are an interesting alternative to the standard exposure in social phobia, especially since studies have shown its usefulness for the fear of public speaking. This paper reports a preliminary study in which a virtual reality therapy (VRT), based on exposure to virtual environments, was used to treat social phobia. The sample consisted of 36 participants diagnosed with social phobia assigned to either VRT or a group-CBT (control condition). The virtual environments used in the treatment recreate four situations dealing with social anxiety: performance, intimacy, scrutiny, and assertiveness. With the help of the therapist, the patient learns adapted cognitions and behaviors in order to reduce anxiety in the corresponding real situations. Both treatments lasted 12 weeks, and sessions were delivered according to a treatment manual. Results showed statistically and clinically significant improvement in both conditions. The effect-sizes comparing the efficacy of VRT to the control traditional group-CBT revealed that the differences between the two treatments are trivial. 76

Virtual reality exposure using three-dimensional images for the treatment of social phobia

“…Despite its open design, the present study used VRE exclusively, whereas the studies of Klinger et al 9 and Robillard et al 12 used VRE combined with CBT, making it difficult to identify which of the two treatments was responsible for improvements. The psychological assessments carried out in the present study were more complete; other studies have measured only the decrease in anxiety, omitting the impact of therapy on social, family, and business aspects.…”

“…[8][9][10][11][12][13]22 However, many of these studies [8][9][10]12,13,22 employed virtual reality systems with immersive headsets, while the virtual reality system used in this study is easier for clinicians to obtain and use in their offices. One study used computer-generated 3D scenes, but the sample was composed only by individuals with public-speaking anxiety, 11 which limits the generalizability of its results.…”

“…20,21 VRE has advantages over imagined or in vivo exposures. [9][10][11]13,22 It can provide standardized and controlled environments, and scenes can be repeated to achieve therapeutic goals. 23,24 Moreover, exposure to virtual environments bridges the gap between an imagined situation and a real one; it allows the patient to be exposed to anxiety-generating stimuli as if he or she were in a real situation.…”

“…10,28 Numerous studies have tried to create and evaluate the use of virtual environments that reproduce anxietygenerating situations. [8][9][10][11][12][13] However, few controlled studies have demonstrated efficacy in the treatment of social phobias. All relevant studies have shown improvements, but with limitations such as the use of participants with circumscribed social phobia 8,[10][11][12][13] ; the use of more complex VRE systems, such as virtual reality headsets [9][10][11][12][13] ; the use of patients on a waiting list for therapy as a control group 11 ; and collection of limited measurements of the phobic experience.…”

Clinical Virtual Reality tools to advance the prevention, assessment, and treatment of PTSD

“…Early efforts to create VH representations appeared in clinical VR scenarios primarily to serve as stimulus ‘props’ to enhance the realism and provocativeness of a virtual world simply by their static presence. For example, VRET applications for the treatment of fear of public speaking and social phobias were successfully deployed using immersive simulations inhabited by ‘still-life’ rendered graphic characters (Anderson, Zimand, Hodges, & Rothbaum, 2005; Klinger et al, 2005; North, North, & Coble, 1998). By adjusting the number and location of such VHs, the intensity of these anxiety-provoking VR contexts could be systematically modulated with the aim to promote fear extinction to improve functioning in the real world with real people.…”